Patient-specific bridging plates

ABSTRACT

Disclosed herein are a bone plating system and a method for utilizing the same. The bone plating system may include first and second bone plates in contact with respective first and second bones, a cross-connector, a cutting guide and a targeter device. The cross-connector may have a first end and an opposite second extending along a longitudinal axis from the first bone plate to the second bone plate. The cutting guide may have an elongate body placed on one of the first or second bones. The targeter device may have a drill guide to align the cross-connector with the first and second bone plates. A method for fixing the bone plating system to the first and second bone may include using the targeter device.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of the filing date of U.S.Provisional Patent Application No. 62/520,957, filed on Jun. 16, 2017,the disclosure of which is hereby incorporated by reference.

FIELD OF THE INVENTION

The present invention generally relates to a bone plating system and amethod for attaching bone plating assembly, and in particular a bridgingbone plate system and a method of implanting a bridging bone plateassembly.

BACKGROUND OF THE INVENTION

Bone plates are generally used for securing bone fragments or multiplebones in a fixed position to facilitate bone fusion and healing. Forexample, a bone fracture may be treated by affixing a bone plate to thefracture area, whereby the bone plate reduces the fracture gap andprovides support for the fractured bone to heal. Bone plates performsimilar functions in treating bone deformities.

Bone plates are typically attached to bone using bone screws. Fixationby bone screws may be insufficient in some instances, especially whenthe bone plate is attached across multiple bones. In some cases, thelocation and number of screw holes on the bone plate is insufficient forproper plate fixation. For example, if the location of a screw holecorresponds to a weak bone area in a patient with osteoporosis, then thebone plate may not be properly secured and the one or more bone portionsmay not be properly aligned.

Treating Charcot or midfoot deformities, for example, may requiremultiple bone plates with multiple bone screws. Such constructs mayincrease the risk of one or more of bone plates being inadequatelysecured to the bones. When multiple bone plates are used, a connectingelement such as a connecting rod or a connecting bolt may be used toattach both bone plates. Connecting elements bridging two bone platesgenerally provide compressive force and may improve the bone plate tobone fixation for both bone plates and simultaneously improve stabilityof bone plate assembly, i.e., bone plates and connecting element.

Attaching two bone plates with a connecting element may be challengingbecause proper alignment between the two bone plates should bemaintained to ensure that the connecting element is properly secured toboth bone plates, while simultaneously ensuring proper bone plate tobone contact is maintained. Further, this alignment must be properlyidentified and maintained during the surgical procedure to allow forproper bone preparation.

Therefore, there exists a need for improved bone plating systems andmethods for implanting the same.

BRIEF SUMMARY OF THE INVENTION

Disclosed herein are bone plating systems and methods for implanting thesame.

In a first aspect of the present invention, a bone plating system isprovided. The bone plating system may have first and second bone plates,a cross-connector, a cutting guide and a targeter device. The first andsecond bone plates may be in contact with respective first and secondbones. The cross-connector may have a first end and an opposite secondend. The cross-connector may extend along a longitudinal axis from thefirst bone plate to the second bone plate. The cutting guide may have anelongate body with a bone contacting surface that may be configured tobe placed on one of the first and second bones to define thelongitudinal axis. The targeter device may have a drill guide to alignthe cross-connector with the first and second bone plates along thelongitudinal axis.

In accordance with the first aspect, the bone plating system may furtherinclude an insert housed within one of the first and second bone plates.The second end of the cross-connector may engage with the insert tosecure the cross-connector about the longitudinal axis. One of the firstand second bone plates with the insert may be movable about at least oneaxis. The one axis may extend through the bone plate when the bone plateis secured to the cross-connector. The insert may be any of a ball jointnut, pivot nut and flexible nut.

In other aspects, the cross-connector may include a first threadedportion which may be used to engage with one of the first and secondbone plates. The cross-connector may include a second threaded portionwhich may be used to engage with the other of the first and second boneplates. The first and second bone plates may have correspondingthreading to engage with the first and second threated portions of thecross-connector.

The second bone plate may include an outer surface which may have acollar portion extending outwardly from the outer surface. The secondend of the cross-connector may be at least partially disposed within thecollar when the cross-connector is secured to the first and second boneplates.

The second bone plate may include a bone contacting surface which mayinclude a collar portion extending outwardly from the bone contactingsurface. The second of the cross-connector may be at least partiallydisposed within the collar when the cross-connector is secured to thefirst and second bone plates.

The first and second bone plates may each have at least one fixationhole. The fixation hole may be configured to receive a fixation elementto secure the first and second bone plates to the respective first andsecond bones. The at least one fixation hole may be a compression slot.

In still other aspects, the first bone plate may contact at least one ofa metatarsal bone, a cuneiform bone, a navicular bone and a talus bone.The second bone plate may contact at least one of a cuboid bone and acalcaneus bone.

The first bone and second bone plates may be preoperatively planned tomatch an outer surface of the respective first and second bones and tosecure the cross-connector along the longitudinal axis.

The cutting guide may have a slot extending through the elongate body.The slot may have a central axis collinear with the longitudinal axis.

The targeter device may include a frame with a first arm and a secondarm. A through hole through each of the first and second arms may definea targeter axis extending from the first arm to the second arm. Thetargeter axis may be collinear with the longitudinal axis when the firstand second arms are engaged with the respective first and second bones.At least one of the first arm and the second arm may be a spring loadedretractable arm such that the targeter device may be retractable alongthe targeter axis. The first and second spring loaded retractable armsmay couple the targeter device to the first and second bone plates suchthat the targeter axis may be collinear with the longitudinal axis. Thelongitudinal axis may be generally transverse to the first and secondbone plates.

In accordance to other aspects, at least a third bone may be disposedbetween the first and second bones. The cross-connector may extendthrough the third bone to secure the first, second and third bones withthe first and second bone plates.

In accordance to other aspects, the cross-connector may have a channelin fluid communication with one or more outlets disposed on an outersurface of the cross-connector. The channel may have an inlet to receivea biologic fluid. The channel may be internal to cross-connector suchthat it forms a cylinder or tube-like structure having an inlet andoutlet.

A second aspect of the present invention is a method of fixing a boneplating system to at least a first bone and a second bone with at leasta third bone disposed between the first and second bones. A method inaccordance with this aspect of the invention may include the steps ofplacing a bone contacting surface of a cutting guide on the first bonesurface, drilling a first hole through a slot in the cutting guide,placing a first bone plate on the first bone and a second bone plate onthe second bone, placing a first arm of targeter device on the firstbone plate and a second arm of the targeter device on the second boneplate, drilling a second hole through the first hole using the first andsecond arms of the targeter device and securing a cross-connectorthrough the second hole. The first and second bone plates may secure thefirst bone, second bone and third bone. The cutting guide may have anelongate body. The drilled hole through the slot in the cutting guidemay extend through the first and second bones.

In a third aspect of the present invention, a bone screw is provided. Abone screw according to this third aspect may include a bore and aninsert configured to be received within the bore. The bore may be influid communication with one or more outlets. The one or more outletsmay be disposed on an exterior surface of the bone screw. The insert mayhave a channel with one or more openings in fluid communication with thechannel. The one or more openings may be disposed on an outer surface ofthe insert. When the insert is placed in the bore, at least one outletmay be in fluid communication with at least one opening. The channel mayinclude a biologic fluid. The bore and channel may be internal to bonescrew and cross-connector respectively such that each forms a cylinderor tube-like structure having an inlet and outlet.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of the presentinvention and the various advantages thereof can be realized byreference to the following detailed descriptions, in which reference ismade to the accompanying drawings:

FIG. 1 is a perspective view of a bone plating assembly according to oneembodiment of the present invention;

FIG. 2 is a another perspective view of the bone plating assembly ofFIG. 1;

FIG. 3A is a perspective view of a lateral bone plate of the boneplating assembly of FIG. 1;

FIGS. 3B and 3C are details of a ball joint nut of the lateral boneplate of FIG. 3A;

FIG. 4 is a perspective view of a bone plating assembly according toanother embodiment of the present invention;

FIG. 5 is a cross-sectional view along line A-A of the bone platingassembly of FIG. 4;

FIG. 6 is a side elevation view of a lateral bone plate of the boneplating assembly of FIG. 4;

FIG. 7A is a perspective view of a bone plating assembly according toyet another embodiment of the present invention;

FIG. 7B is a side elevation view of a lateral bone plate of the boneplating assembly of FIG. 7A;

FIG. 8 is a perspective view of a targeter device according to anembodiment of the present invention;

FIG. 9 is perspective view of a targeter device according to anotherembodiment of the present invention;

FIGS. 10A-10D are perspective view of a bone plating system showing thesequential steps of attaching the bone plating assembly of FIG. 1;

FIG. 11 is a side view of a bone screw according to another embodimentof the present invention;

FIG. 12 is a perspective cross-sectional view along line L1 of the boneplating system of FIG. 10A with the bone screw of FIG. 11;

FIG. 13 is side view of a bone screw according to another embodiment ofthe present invention;

FIG. 14A is a side view of a first insert for the bone screw of FIG. 13;

FIG. 14B is side view of the bone screw of FIG. 13 in conjunction withthe first insert, and

FIG. 15A is a side view of a second insert for the bone screw of FIG.13, and

FIG. 15B is a side view of the bone screw of FIG. 13 in conjunction withthe second insert.

DETAILED DESCRIPTION

In describing preferred embodiments of the disclosure, reference will bemade to directional nomenclature used in describing the human body. Itis noted that this nomenclature is used only for convenience and that itis not intended to be limiting with respect to the scope of theinvention.

As used herein, when referring to bones or other parts of the body, theterm “anterior” means toward the front part or the face and the term“posterior” means toward the back of the body. The term “medial” meanstoward the midline of the body and the term “lateral” means away fromthe midline of the body. The term “superior” means closer to the heartand the term “inferior” means more distant from the heart.

Referring to FIG. 1, there is shown a perspective view of a bone platingassembly 100. Bone plating assembly 100 includes a medial bone plate110, a lateral bone plate 120 and a cross-connector 130 joining the boneplates. Medial bone plate 110 has a generally rigid elongate body with afirst bone contacting surface 112 and an opposite first surface 114.First bone contacting surface 112 is configured to match bone profile. Aplurality of screw holes 116 configured to receive bone screws 118 arelocated throughout medial bone plate 110. A centrally located firstfixation hole 122 allows cross-connector 130 to be coupled with medialbone plate 110. Whereas fixation hole 122 is centrally located on medialbone 110 in this embodiment, other embodiments may have fixation hole122 located at different locations on medial bone plate 110. Centralpositioning of first fixation hole 122 allows for improved fixationbetween cross-connector 130 and medial bone plate 110, whereby stressinduced by the cross-connector on medial bone plate 110 is evenlydistributed across the bone plate.

Lateral bone plate 120 is also a rigid elongate plate with a second bonecontacting surface 124 and an opposite second surface 126. Similar tothe medial bone plate 110, second bone contacting surface 124 isconfigured to match profile of bone surface(s) on which lateral plate120 is implanted. A plurality of screw holes 128 configured to acceptbone screws 132 are located at one end of medial bone plate 120. Anopposite end of medial bone plate 120 includes a second fixation hole134 to engage with cross-connector 130. Second fixation hole 134 isdisposed within a collar 136. Cross-connector 130 includes a threadedportion 138 to engage with second fixation hole 134 of medial bone plate120. As best seen in FIG. 1, a central axis L1 of cross-connector 130 isaligned with first fixation hole 122 and second fixation hole 134.

FIG. 2 is another perspective view of bone plating assembly 100implanted on a human foot. Medial bone plate 110 is attached by bonescrews 118 to a metatarsal bone 140, a medial cuneiform bone 142, and anavicular bone 144 and rigidly secures these bones. Similarly, lateralbone plate 120 is attached by bone screws 132 and rigidly secures acuboid bone 146 and a calcaneus bone 148. Cross-connector 130 passesthrough medial cuneiform bone 142, an intermediate cuneiform bone 150, alateral cuneiform bone 152 and cuboid bone 146. As shown in the presentembodiment, there are at least two other bone, i.e., medial andintermediate cuneiform bones 150, 152, between medial bone plate 110 andlateral bone plate 120. When fully implanted, bone plate assembly 100ensures that in addition to bone plates 110, 120 rigidly securing bones140, 142, 144, 146, 148, the cross-connector 130 coupling the boneplates applies a compressive force across bones 150,152. While bonescrews 118, 132 secure bone plates 110, 120 respectively, thecross-connector compressive force reinforces the bone plate to boneattachment and provides greater fixation between bone plates and bonesas compared to fixation achieved with only bone screws.

Referring now to FIG. 3A, there is shown a perspective view of lateralbone plate 120 implanted on cuboid bone 146 and calcaneus bone 148. Alongitudinal axis L2 extending through the center of lateral bone plat120 intersects with central axis L1 of cross-connector 130. As bestshown in FIGS. 3B and 3C, second fixation hole 134 includes a ball nutjoint 154 housed in second fixation hole 134. Threaded portion 138 ofcross-connector 130 is configured to engage with a threaded portion 156of ball nut joint 154. Ball nut joint 154 allows lateral bone plate 120to pivot about an intersection 156 of longitudinal axis L2 and centralaxis L1 when lateral bone plate 120 is threadingly secured withcross-connector 130. As shown in FIG. 3A, ball joint nut 154 allowslateral bone plate 120 to pivot about intersection 156 along axis L1 andaxis L2 indicated by rotation arrows 158 and 160 respectively. Pivotingcapability allows for greater flexibility in attaching lateral boneplate 120 to cuboid bone 146 and calcaneus bone 148, whereby lateralbone plate 120 may be adjusted and positioned as desired over bones 146,148 even after being firmly secured to cross-connector 130. While a ballnut joint providing multi-axial freedom for lateral bone plate 120 isshown in this embodiment, other embodiments may have other jointmechanisms that may allow freedom only along certain axes.

FIG. 4 is a perspective view of bone plating assembly 200 according toanother embodiment. Bone plating assembly 200 is similar to bone platingassembly 100, and therefore like elements are referred to with similarreference numerals within the 200-series. For instance, bone platingassembly 200 also includes a medial bone plate 210, a lateral bone plate220 and a cross-connector 230. However, a collar 237 enclosing secondfixation hole 234 does not have a ball nut joint in this embodiment. Across-section of bone plating assembly 200 taken along line A-A of FIG.4 is shown in FIG. 5. Similar to bone plating assembly 100,cross-connector 230 passes through medial cuneiform bone 142, anintermediate cuneiform bone 150, a lateral cuneiform bone 152 and cuboidbone 142.

FIG. 6 shows a side elevation view of lateral bone plate 220. Collar 237has internal threading 257 configured to be secured with threading 238of cross-connector 220 as best shown in FIG. 5. In this embodiment,lateral bone plate 220 is locked into position with respect to thecross-connector, when cross-connector 220 is threadingly secured tolateral bone plate 220. A tapered section 262 extends distally from thesecond fixation hole 234 and allows for improved contact between lateralbone plate 220 and cuboid bone 142 (not shown).

FIG. 7A is a perspective view of bone plating assembly 300 according toanother embodiment. Bone plating assembly 300 is similar to bone platingassembly 200, and therefore like elements are referred to with similarreference numerals within the 300-series. For instance, bone platingassembly 300 also includes a medial bone plate 310, a lateral bone plate320 and a cross-connector 330. However, a collar 339 enclosing secondfixation hole 334 extends away from opposite second surface 326 of thelateral bone plate 320 in this embodiment. Consequently, second bonecontacting surface 324 has a generally planar surface requiring lessbone resection to place and secure lateral bone plate 320 on bone.Collar 339 is provided with internal threading 341 as best shown in sideelevation view of lateral bone plate 320 in FIG. 7B. Threaded portion338 of cross-connector 330 is configured to threadingly engage withinternal threading 341 of lateral bone plate 320.

Bone screw holes and fixation holes may be threaded, non-threaded ormade of deformable material as used in technologies such as theSmartlock System. Compatible bone screws including locking andnonlocking screws may be used to attach bone plates to bone. Bone platesmay also be provided with other features including, but not limited to,compression slots, blind holes, suture anchors, and locking holes. Bonescrew holes, fixation holes, and other features may be provided in anyconfiguration across the bone plates. Preoperative planning may be usedto determine optimum screw hole and fixation hole layout across boneplates. Bone plating assemblies of the present disclosure may also beused in conjunction with patient-specific plating systems includingcustomized bone plates as disclosed in U.S. Provisional Application No.62/482,422, the disclosure of which is hereby incorporated by referenceherein.

FIG. 8 is a perspective view of a targeter device 400 according to anembodiment of the present invention. Targeter device 400 is shown inconjunction with bone plating assembly 100. Targeter device 400 isgenerally U-shaped and includes an expandable frame with a first leg 402and a second leg 404. Second leg 404 is slidably coupled with first leg402 at a distal end of targeter device 400. A spring 406 (not shown) ishoused within the coupled region of the first and second leg such thatthe first and second leg are biased to move towards each other asindicated by directional arrows 408. A first column 410 and a secondcolumn 412 are attached to the proximal ends of first leg 402 and secondleg 404 respectively. The distance between first column 410 and secondcolumn 412 may be adjusted by manually pulling the columns apart tocompress spring 406, and therefore targeter device 400 can function asan expandable clamp for bone or bone assemblies of varying sizes. Firstcolumn 410 and second column 412 are generally cylindrical with hollowinteriors. The hollow interiors have a central targeter axis L3 whichaligns with the central axis of the cross-connector L1 when first column410 contacts medial bone plate 110 and second column 412 contactslateral bone plate 120 as best shown in FIG. 8. Slidably coupled legs402, 404 and spring bias 406 ensure that bone plates 110, 120 aresecurely held in place by functioning as a compression and distractiontool. Columns 410, 412 may now serve as drill guides to drill across-connector 130 hole. While a spring bias working in conjunctionwith slidable legs is shown in this embodiment, other embodiments mayhave other mechanisms to force columns 410, 412 towards each other.

Referring now to FIG. 9, there is shown a perspective view of a targeterdevice 500 according to another embodiment. Targeter device 500 issimilar to targeter device 400, and therefore like elements are referredto with similar reference numerals within the 500-series. First leg 502and second leg 504 are not attached at a distal end in this embodiment.Consequently, placing first column 510 (not shown) on medial bone plate110 and second column 512 on lateral bone plate 120 may be independentlyperformed. This provides additional flexibility in placing targeterdevice 500 on target bones where accessibility is more constrainedbecause columns 510, 512 may be individually placed on target sitewithout requiring additional space for a jointed distal end.

Another aspect of the present invention is a method is for attaching abone plating assembly to multiple bones. Referring now to FIGS. 10A-10D,there is shown a method for implanting a bone plating assembly 100during a surgical procedure such as Charcot arthropathy. A cutting guide600 is placed on a medial side of a human foot across metatarsal bone140, medial cuneiform bone 142, and navicular bone 144 as shown in FIG.10A. Cutting guide 600 includes multiple slots for guidewire 604attachment to bones 140, 142, 144. A central slot 606 having a centralaxis is aligned with the intended placement of cross-connector 130 byensuring that this central axis is collinear with central axis ofcross-connector L1. After securing cutting guide 600 by attachingguidewires 604 to bones 140, 142, 144, a hole is drilled along axis L1.A long guidewire 602 is placed in this hole. As best seen in FIG. 10A, acentral axis of long guidewire 602 is collinear to axis L1. Cuttingguide 600 is then removed along with some of the guidewires leavingbehind at least a few guidewires 604. A first counterbore 608 on medialcuneiform bone 142 and a second counterbore 610 on cuboid bone 146 areresected as shown in FIG. 10B. A drill column 612 paced over longguidewire 602 ensures that counterbore holes 608,610 are aligned withaxis L1.

Medial bone plate 110 is placed over bones 140, 142, 144, with the helpof the remaining guidewires 604 such that first fixation hole 122 fitsinto counterbore 608. Similarly, lateral bone plate 120 is placed overbones 146, 148 with collar 136 being positioned in counterbore 610.Targeter device 400 is then used to secure and position bone plates 110,120. First column 410 and second column 412 are retracted manually bypulling them apart to slide first leg 402 into second leg 404. Targeterdevice 400 is then placed on bone plates 110, 120, and aligned to ensurethat targeter axis L3 is collinear with cross-connector axis L1. Whenthe manual force to pull columns 410, 412 is removed, bias spring 406forces columns towards each other to securely hold bone plates in place.Once proper alignment is confirmed, i.e., when axis L3 is collinear withL1, a few bone screws 118, 132 may be used to secure bone plates 110,120. First column 410 and second column 412 may now be used as atelescopic drill guide to drill hole for cross-connector 130.Cross-connector 130 may then be fastened to medial bone plate 110 andlateral bone plate 120 to complete the implantation of bone plateassembly 100.

Prior to implantation of bone plate assembly 100, preoperative planningmay be performed to customize and specifically design bone plates 110,120 and cross-connector 130 for patient specific requirements.Patient-specific bone plating assembly 100 may then be implanted usinguniversal tools such as cutting guide 600 and targeter device 400 whichare compatible with bone plates of varying sizes.

While a bone plating assembly for a midfoot procedure such as Charcotarthropathy is described in these embodiments, bone plate assemblies,targeter device and cutting guide disclosed herein may be used in othersurgical procedures. Various bone plate shapes and contours may bedesigned and fabricated to conform with specific bone requirements. Thenumber of bones disposed between the plates may also be varied withoutdeparting from the scope of the present invention. Bone plates of thepresent invention may be made from any of, but not limited to, PEEK,polymers and titanium and/or titanium alloys, stainless steel, andcobalt chrome. Additive manufacturing techniques such as 3D printing maybe used to fabricate bone plates. Cross-connector threaded portion maybe limited to one end or two ends, or may be fully threaded.

Referring now to FIGS. 11 and 12, there is shown a bone screw 530according to an embodiment of the present invention. Medial plate 510and lateral plate 520 of bone screw 530 is secured across intermediatecuneiform bone 150 and lateral cuneiform bone 152 respectively. Multiplebiologic outlets 532 are disposed on the surface of bone screw 530. Eachbiologic outlet 532 is in fluid communication with an internal biologicchannel 536 as best shown in FIG. 12. The location of biologic outlets532 across bone screw 530 are configured for the precise dispersal of abiologic fluid at the desired locations. Once the bone screw is securedto the plates and the bone, the biologic fluid can be introduced throughan inlet 538. The biologic fluid fills channel 536 and flows throughoutlets 532 to the desired locations. The biologic fluid within channel536 reinforces and strengthens bone screw 530. As best shown in FIG. 11,outlets 532 can be located in threaded portion 525 of bone screw 530between threads 534 or in an unthreaded portion of the bone screw. Thethreaded portion can include single or double start threads, forexample, or forward or reverse threading depending on the bone screwinsertion area and bone type.

FIG. 13 shows a bone screw 630 according to another embodiment of thepresent invention. Bone screw 630 includes three biologic outlets 632 a,632 b and 632 c located between screw threads 634 across the bone screw.Bone screw 630 may include more or less than three biological outlets632 in other embodiments. Biological outlets 632 each include alongitudinal axis which may be parallel or transverse to one another.Each biological outlet 632 has a diameter D1. Respective diameters D1 ofbiological outlets 632 may be less than, equal to or greater than oneanother. Biological outlets 632 generally have a constant diameter fromtheir respective inlets and outlets but may have a varying diameterforming a conical shape for example. In such embodiments, biologicaloutlets 632 may have a greater diameter at the inlet than at its outletfor example. In other embodiments, biological outlets 632 may include aninner ledge such that it includes first and second cylindrical portionshaving respective larger and smaller diameters. In yet otherembodiments, biological outlets 632 may include a tapered portionintermediate first and second cylindrical portions of increasing ordecreasing diameters for example. Bone screw 630 includes an internalchannel (not shown) configured to receive an insert to control theopening and closing of the biologic outlets. For example, a first insert635 a as shown in FIG. 14A includes an opening 632 c′. When first insert635 a is introduced into bone screw 630 a as shown in FIG. 14B, outlets632 a and 632 b are closed leaving only outlet 632 c in fluidcommunication with an internal channel of the insert.

FIG. 15A shows a second insert 635 b having openings 632 a′ and 632 b′corresponding to outlets 632 a and 632 b. When second insert 635 b isinserted into bone screw 630 b only outlets 632 a and 632 b are in fluidcommunication with an internal channel of the insert as best shown inFIG. 15B. Bone screws in other embodiments can have various numbers ofbiologic outlets disposed along the bone screws and can be paired withcorresponding inserts to control opening and closing of the biologicoutlets as desired. Biologic fluids can include bone cements such aspolymethyl methacrylate (“PMMA”), methyl methacrylate (“MMA”), etc., toanchor joints and fractured bones. While a bone screw bridging twoplates is described here, other embodiments may have include bone screwswith biologic outlets secured in conjunction with one or more boneplates. Bone screws with biologic outlets described here can also beused with other implants in other embodiments of the present disclosure.

Furthermore, although the invention disclosed herein has been describedwith reference to particular features, it is to be understood that thesefeatures are merely illustrative of the principles and applications ofthe present invention. It is therefore to be understood that numerousmodifications, including changes in the sizes of the various featuresdescribed herein, may be made to the illustrative embodiments and thatother arrangements may be devised without departing from the spirit andscope of the present invention. In this regard, the present inventionencompasses numerous additional features in addition to those specificfeatures set forth in the paragraphs below. Moreover, the foregoingdisclosure should be taken by way of illustration rather than by way oflimitation as the present invention is defined in the examples of thenumbered paragraphs, which describe features in accordance with variousembodiments of the invention, set forth in the claims below.

1. A bone plating system comprising: first and second bone plates beingin contact with respective first and second bones; a cross-connectorhaving a first end and an opposite second end, the cross-connectorextending along a longitudinal axis from the first bone plate to thesecond bone plate; a cutting guide having an elongate body with a bonecontacting surface configured to be placed on one of the first andsecond bones to define the longitudinal axis; and a targeter devicehaving a drill guide to align the cross-connector with the first andsecond bone plates along the longitudinal axis.
 2. The bone platingsystem of claim 1, further comprising an insert housed within one of thefirst and second bone plates, wherein the second end of thecross-connector engages with the insert to secure the cross-connectorabout the longitudinal axis.
 3. The bone plating system of claim 2,wherein one of the first and second bone plates with the insert ismoveable about at least one axis extending through said bone plate whensaid bone plate is secured to the cross-connector.
 4. The bone platingsystem of claim 2, wherein the insert is any of a ball joint nut, pivotnut and flexible nut.
 5. The bone plating system of claim 1, wherein thecross-connector includes a first threaded portion to engage with one ofthe first and second bone plates.
 6. The bone plating system of claim 1,wherein an outer surface of the second bone plate includes a collarportion extending outwardly therefrom, the second end of thecross-connector being at least partially disposed within the collar whenthe cross-connector is secured to the first and second bone plates. 7.The bone plating system of claim 1, wherein a bone contacting surface ofthe second bone plate includes a collar portion extending outwardlythereofrom, the second end of the cross-connector being at leastpartially disposed within the collar when the cross-connector is securedto the first and second bone plates.
 8. The bone plating system of claim1, wherein the first and second bone plates each have at least onefixation hole configured to receive a fixation element to secure thefirst and second bone plates to the respective first and second bones.9. The bone plating system of claim 8, wherein the at least one fixationhole is a compression slot.
 10. The bone plating system of claim 1,wherein the first bone plate contacts at least one of a metatarsal bone,a cuneiform bone, a navicular bone and a talus bone and the second boneplate contacts at least one of a cuboid bone and a calcaneus bone. 11.The bone plating system of claim 1, wherein the first bone and secondbone plates are preoperatively planned to match an outer surface of therespective first and second bones and to secure the cross-connectoralong the longitudinal axis.
 12. The bone plating system of claim 1,wherein the cutting guide has a slot extending through the elongatebody, the slot having a central axis collinear with the longitudinalaxis.
 13. The bone plating system of claim 1, the targeter devicefurther comprising a frame having a first arm and a second arm, athrough hole through each of the first and second arms defining atargeter axis extending from the first arm to the second arm, thetargeter axis being collinear with the longitudinal axis when the firstand second arms are engaged with the respective first and second bones.14. The bone plating system of claim 13, wherein at least one of thefirst arm and the second arm is a spring loaded retractable arm suchthat the targeter device is retractable along the targeter axis.
 15. Thebone plating system of claim 14, wherein the first and second springloaded retractable arms couple the targeter device to the first andsecond bone plates such that the targeter axis is collinear with thelongitudinal axis.
 16. The bone plating system of claim 1, wherein atleast a third bone is disposed between the first and second bones suchthat the cross-connector extends through the third bone to secure thefirst, second and third bones with the first and second bone plates. 17.The bone plating system of claim 1, wherein the cross-connector includesan internal channel in fluid communication with one or more outletsdisposed on an outer surface of the cross-connector, the internalchannel having an inlet to receive a biologic fluid.
 18. A method offixing a bone plating system to at least a first bone and a second bonewith at least a third bone disposed between the first and second bonescomprising: placing a bone contacting surface of a cutting guide havingan elongate body on the first bone surface; drilling a first holethrough a slot in the cutting guide, the hole extending through thefirst and second bones; placing a first bone plate on the first bone anda second bone plate on the second bone; placing a first arm of targeterdevice on the first bone plate and a second arm of the targeter deviceon the second bone plate drilling a second hole through the first holeusing the first and second arms of the targeter device; and securing across-connector through the second hole such that the first bone, secondbone and third bone are secured by the first and second bone plates. 19.A bone screw comprising: a bore in fluid communication with one or moreoutlets, the one or more outlets disposed on an exterior surface of thebone screw, and an insert configured to be received within the internalbore, the insert having a channel with one or more openings in fluidcommunication with the internal channel, the one or more openingsdisposed on an outer surface of the insert, wherein when the insert isplaced in the bore at least one outlet is in fluid communication with atleast one of the one or more openings.
 20. The bone screw of claim 19,wherein the internal channel includes a biologic fluid.